Dr. Richard Shulman

Capacity Evaluation: the Role of Corroborative Information

By Dr. Richard Shulman • October 24, 2023 • 3 Comments

In clinical geriatric psychiatry, it is an accepted standard of care to obtain corroborative information when conducting clinical evaluations.However, medical-legal tasks of capacity evaluation, such as for the evaluation of capacity to instruct counsel, testamentary capacity and possibly even capacity to appoint powers of attorney, may require strict confidentiality which prevents obtaining corroborative information from informants. As a result, obtaining corroborative information for capacity evaluation in this context is more complex than in clinical care.

Suggested Instructions for Attorneys for Personal Care: Limitations of Authority

By Dr. Richard Shulman • August 1, 2023 • 2 Comments

It is just as important to know the limitations of a power of attorney for personal care as it is to know your responsibilities.

The Bio-Psycho-Social Approach to Capacity Evaluation

By Dr. Richard Shulman • May 9, 2023 • 0 Comments

Current approaches that define capacity in cognitive terms disregard concerns that emotional instability may disrupt capacity or that a person may be cognitively intact yet lack the capacity to give a valid consent. An alternative evaluative approach would be to view capacity holistically, as a combination of biological, psychological, and social (biopsychosocial) factors.

More Commentary on the Evaluation of Capacity to Consent for MAiD

By Dr. Richard Shulman • January 17, 2023 • 1 Comment

There appears to be a lack of consensus in the mental health field whether persons with a mental disorder-sole underlying medical condition can be adequately evaluated for capacity to consent to MAiD.

Update on Suggested Amendment for Capacity to Consent to MAiD

By Dr. Richard Shulman • October 27, 2022 • 1 Comment

I suggest “an appreciation of the impact MAiD will have on family members and friends” be included in fulfilling the proposed amendment of the appreciation test for consenting to MAiD. The proposed amendment would not mandate being bound by others’ opinions, but that that lack of ability to appreciate the views of one’s significant others would demonstrate a lack of ability to apply the relevant information to one’s circumstances.

Update on MAiD: Mental Disorder as a Sole Underlying Medical Condition

By Dr. Richard Shulman • July 26, 2022 • 0 Comments

In Canada, the law no longer restricts medical assistance in dying (MAiD) to people whose death is reasonably foreseeable: as of March 17, 2023, people with a mental disorder as a sole underlying medical condition (MD-SUMC) will be eligible for MAiD.

Capacity to Consent to MAiD: A Suggestion For Amendment

By Dr. Richard Shulman • April 28, 2022 • 0 Comments

I have found it uncommon for a family member or beneficiary to exert undue influence to pressure a patient to pursue MAiD. What worries me is the vulnerability of patients to undue influence from physicians who may embrace therapeutic nihilism and bias patients unduly towards MAiD. I suggest that, for capacity to consent to MAiD, the test of “ability to appreciate” should be expanded to require an appreciation of the views and wishes of supportive family members and friends.

Role of the Health Practitioner at Board Hearings: Recommendation for Reform

By Dr. Richard Shulman • January 24, 2022 • 1 Comment

The Consent and Capacity Board (“Board”) in Ontario is a quasi-judicial administrative tribunal which operates at arm’s length from the Ministry of Health. The Board convenes hearings and makes decisions under six pieces of legislation, but most hearings relate to the Health Care Consent Act (HCCA) and the Mental Health…

Dementia, Health Law and Discharge Planning Challenges

By Dr. Richard Shulman • October 29, 2021 • 1 Comment

A clinical dilemma: a patient was diagnosed with dementia in the mild-to-moderate stage requested to be discharged home from hospital to live alone despite the opinion of the attorney for personal care and property that the patient is unsafe to do so. The clinical opinion was also that the patient…

Changes to Consent to Medical Assistance in Dying

By Dr. Richard Shulman • July 27, 2021 • 1 Comment

Changes to MAiD laws will allow some patients whose deaths are foreseeable to provide advance directives regarding medical assistance in dying.